Topic: Suicide
Target Population: Adults
Sector: Community-Based, School-Based, Work Site
Military Sector: Veterans Affairs
This program is for adults who are in positions to recognize and refer someone who may be at risk for suicide.
The Question, Persuade, Refer Gatekeeper Training for Suicide Prevention (QPR Gatekeeper Training) program is designed to teach adults how to identify individuals who are or may be at risk for suicide and take action to prevent any destructive behavior.
A randomized controlled trial of 32 schools found that compared to wait-list control groups, participants trained in QPR Gatekeeper Training demonstrated an increased knowledge of suicide issues, an increase in abilities to ask suitable questions about suicide, better awareness of school policies regarding suicidal students, and an increase in abilities to use referral resources for suicidal students. Program effects were maintained 1 year after treatment. A number of single-group studies with pretest and posttest measures or short-term follow-ups have demonstrated significant improvements in knowledge, attitudes, subjective norms, self-efficacy and intention to intervene, and likelihood of intervening. One pretest/posttest study with no control group was conducted in a group of clinical and non-clinical staff working for the Department of Veterans Affairs, and results demonstrated significant increases in knowledge and self-efficacy. In addition, results from one study indicated the need for a culturally inclusive adaptation of the program and for the addition of booster sessions to maintain improvements at posttest.
QPR Gatekeeper Training is available online or through live training sessions and is hosted by Certified QPR Gatekeeper Instructors. The program intends to teach participants how to intervene in order to prevent another person's suicide. The target skills taught to participants follow the acronym QPR (Question, Persuade, and Refer).
Additionally, there are specialized courses for different professionals including clergy, law enforcement, first responders, healthcare workers, and veteran-care providers. Additional courses that provide opportunities for extended learning are also available. Please visit https://qprinstitute.com/professional-training for more information.
Over five million people around the world have been trained in QPR Gatekeeper Training.
Program facilitators, who must be 18 years old or older, do not need any special educational background or experience, but they must become certified. Certification training is available in several formats, including a self-paced course that can be completed at home, a workshop setting with local peers, or a virtual course. A 3-year certification costs $595. Please visit https://qprinstitute.com/become-an-instructor for more information.
Considerations for implementing this program include recruiting instructors and making arrangements for them to complete training, acquiring participant buy-in, locating space if implementing the program in person, and ensuring participants have access to a computer with internet capabilities if they are completing the online version of the program.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing QPR Gatekeeper Training, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Online and in-person classes last approximately 1 hour. Facilitator planning and preparation will vary and could be extensive.
Implementation costs will vary depending on the format of delivery and the audience. Please use details in the Contact section to learn more. Additional cost information may be found at https://qprinstitute.com/store
To move the QPR Gatekeeper Training program to the Effective category on the Clearinghouse Continuum of Evidence at least one external evaluation must be conducted that demonstrates sustained, positive outcomes. This study must be conducted independently of the program developer.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact QPR by phone 1-888-726-7926 or visit https://qprinstitute.com/
Bartkowski, J. P., Klee, K., & Xu, X. (2024). Expanding the question–persuade–refer (QPR) evidence base: Youth suicide prevention among the Mississippi band of Choctaw Indians. Healthcare, 12(8), 834. https://doi.org/10.3390/healthcare12080834
Cerel, J., Padgett, J. H., Robbins, V., & Kaminer, B. (2012). A state's approach to suicide prevention awareness: Gatekeeper training in Kentucky. Journal of Evidence-Based Social Work, 9(3), 283-292. https://doi.org/10.1080/15433714.2010.498672
Coleman, D., & Del Quest, A. (2015). Science from evaluation: Testing hypotheses about differential effects of three youth-focused suicide prevention trainings. Social Work in Public Health, 30(2), 117-128. https://doi.org/10.1080/19371918.2014.938397
Hussain, F. Z., Borntrager, L. J., Lindsey, M., Karimi-Dehkordi, D., Matha, S., Hughes, T. P., … Gryglewicz, K. (2025). Examining racial and ethnic disparities in the effectiveness of question, persuade, refer (QPR) suicide prevention training among Black, Hispanic, and White community helpers. Journal of Racial and Ethnic Health Disparities, https://doi.org/10.1007/s40615-025-02571-x
Johnson, L. A., & Parsons, M. E. (2012). Adolescent suicide prevention in a school setting: Use of a gatekeeper program. NASN School Nurse, 27(6), 312-317. https://doi.org/10.1177/1942602X12454459
Kreuze, E., York, J., Lamis, D. A., Jenkins, C., Quinnett, P., Mueller, M., & Ruggiero, K. J. (2025). Gatekeeper training for youth suicide prevention: A mixed method comparative analysis of two online programs. Psychology in the Schools, 62(2), 492-511. https://doi.org/10.1002/pits.23335
Lu, T. H., Lin, S. H., Pi, Y. Y., Lu, C. R., Wang, S. H., Huang, C. N., & Chen, P. S. (2022). Effects of the QPR (question, persuade, refer) strategy on suicidal prevention among general medical staff and consultation-liaison psychiatrists: A single center, naturalistic study. Journal of Suicidology, 17(1), 67-71.
Lyon, N. R., Thomas, R., & Kwasky, A. N. (2024). One-hour suicide prevention training makes a difference. Journal of Christian Nursing, 41(3), 144-151. https://doi.org/10.1097/CNJ.0000000000001189
Matthieu, M. M., Chen, Y., Schohn, M., Lantinga, L. J., & Knox, K. L. (2009). Educational preferences and outcomes from suicide prevention training in the veterans health administration: One-year follow-up with healthcare employees in upstate New York. Military Medicine, 174(11), 1123-1131. https://doi.org/10.7205/MILMED-D-00-1109
Matthieu, M. M., Cross, W., Batres, A. R., Flora, C. M., & Knox, K. L. (2008). Evaluation of gatekeeper training for suicide prevention in veterans. Archives of Suicide Research, 12(2), 148-154. https://doi.org/10.1080/13811110701857491
Wood, D. S., Ohri, F., Hudnall, G., & Cahoon, L. (2023). Suicide gatekeeper training outcomes in educational and religious settings. Journal of Human Behavior in the Social Environment, 33(2), 225-231.
Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., & Pena, J. B. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104-115. https://doi.org/10.1037/0022-006X.76.1.104
Adams, L. M., Nguyen, T., Morgan, K. B., & Gumbleton, C. (2018). RU OK: Evaluating the effectiveness of a gatekeeper training program. Journal of College Student Development, 59(5), 614-617. https://doi.org/10.1353/csd.2018.0056
Aldrich, R. S., Wilde, J., & Miller, E. (2018). The effectiveness of QPR suicide prevention training. Health Education Journal, 77(8), 964-977. https://doi.org/10.1177/0017896918786009
Cross, W. F., Seaburn, D., Gibbs, D., Schmeelk-Cone, K., White, A. M., & Caine, E. D. (2011). Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills. The Journal of Primary Prevention, 32(3-4), 195-211. https://doi.org/10.1007/s10935-011-0250-z
Cross, W., Matthieu, M. M., Cerel, J., & Knox, K. L. (2007). Proximate outcomes of gatekeeper training for suicide prevention in the workplace. Suicide & Life-Threatening Behavior, 37(6), 659-670. https://doi.org/10.1521/suli.2007.37.6.659
Cross, W., Matthieu, M. M., Lezine, D., & Knox, K. L. (2010). Does a brief suicide prevention gatekeeper training program enhance observed skills? Crisis: The Journal of Crisis Intervention and Suicide Prevention, 31(3), 149-159. https://doi.org/10.1027/0227-5910/a000014
Deane, F. P., Williams, G., Byrne, M. K., Longbottom, W., Weston, T. N., Hunt, B., ... & Regan, J. L. (2024). Changes in suicide literacy and intentions to ask about suicide: “community linker” training for those supporting Aboriginal people. Mental Health & Prevention, 36, 200369.
Gryglewicz, K., Garrison, C. M. T., Childs, K. K., Labouliere, C. D., & Karver, M. S. (2024). Examining individual and service delivery context variables and their association with the effectiveness of QPR suicide prevention gatekeeper training. Administration and Policy in Mental Health and Mental Health Services Research, 51(1), 47-59.
Hangartner, R. B., Totura, C. M. W., Labouliere, C. D., Gryglewicz, K., & Karver, M. S. (2019). Benchmarking the “question, persuade, refer” program against evaluations of established suicide prevention gatekeeper trainings. Suicide & Life-Threatening Behavior, 49(2), 353-370. https://doi.org/10.1111/sltb.12430
Keller, D. P., Schut, L. J. A., Puddy, R. W., Williams, L., Stephens, R. L., McKeon, R., & Lubell, K. (2009). Tennessee lives count: Statewide gatekeeper training for youth suicide prevention. Professional Psychology, Research and Practice, 40(2), 126-133. https://doi.org/10.1037/a0014889
Lancaster, P. G., Moore, J. T., Putter, S. E., Chen, P. Y., Cigularov, K. P., Baker, A., & Quinnett, P. (2014). Feasibility of a web-based gatekeeper training: Implications for suicide prevention. Suicide & Life-Threatening Behavior, 44(5), 510-523. https://doi.org/10.1111/sltb.12086
Lee, P. I., & Wu, C. Y. (2025). A feasibility study of an AI-based virtual human training design in suicide gatekeeper education. Medical Teacher, 1-9.
Levkovich, I., Haber, Y., Levi-Belz, Y., & Elyoseph, Z. (2025). A step toward the future? Evaluating GenAI QPR simulation training for mental health gatekeepers. Frontiers in Medicine, 12, 1599900. https://doi.org/10.3389/fmed.2025.1599900
Litteken, C., & Sale, E. (2018). Long-term effectiveness of the question, persuade, refer (QPR) suicide prevention gatekeeper training program: Lessons from Missouri. Community Mental Health Journal, 54(3), 282-292. https://doi.org/10.1007/s10597-017-0158-z
Mitchell, S. L., Kader, M., Darrow, S. A., Haggerty, M. Z., & Keating, N. L. (2013). Evaluating question, persuade, refer (QPR) suicide prevention training in a college setting. Journal of College Student Psychotherapy, 27(2), 138-148. https://doi.org/10.1080/87568225.2013.766109
Østergaard, L. R., Bast, L. S., O'Connor, R. C., & Christiansen, E. (2025). Feasibility of a school‐based suicide prevention gatekeeper intervention and an implementation intervention (project ROS): Study protocol. Early Intervention in Psychiatry, 19(5), e70050. https://doi.org/10.1111/eip.70050
Peterson, A. L., Monahan, M. F., Bender, A. M., Gryglewicz, K., & Karver, M. S. (2021). Don’t invite everyone! Training variables impacting the effectiveness of QPR trainings. Administration and Policy in Mental Health and Mental Health Services Research, 48(2), 343-353.
Pullen, J. M., Gilje, F., & Tesar, E. (2016). A descriptive study of baccalaureate nursing students' responses to suicide prevention education. Nurse Education in Practice, 16(1), 104-110. https://doi.org/10.1016/j.nepr.2015.09.007
Quinnett, P. G. (2023). The certified QPR pathfinder training program: A description of a novel public health gatekeeper training program to mitigate suicidal ideation and suicide deaths. Journal of Prevention, 44(6), 813-824. https://doi.org/10.1007/s10935-023-00748-w
Reis, C., & Cornell, D. (2008). An evaluation of suicide gatekeeper training for school counselors and teachers. Professional School Counseling, 11(6), 386-394. https://doi.org/10.1177/2156759X0801100605
Samuolis, J., Harrison, A. J., & Flanagan, K. (2020). Evaluation of a peer-led implementation of a suicide prevention gatekeeper training program for college students. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(5), 331-336. https://doi.org/10.1027/0227-5910/a000638
Sullivan, A., Montgomery, A. E., Blosnich, J. R., Pavela, G., & Fifolt, M. (2024). A qualitative exploration of question, persuade, refer (QPR) gatekeeper training by the Alabama suicide prevention and resources coalition. Mental Health & Prevention, 36. https://doi.org/10.1016/j.mhp.2024.200375
Thumbochetty, G., Mathew, N. S., Devotta, M. F., Moses, N. V., Gupta, A. R., & De Sousa, A. (2025). Efficacy of question, persuade, and refer gatekeeper training and emotional first aid in the Indian population. Annals of Indian Psychiatry, 9(3), 227-233. https://doi.org/10.4103/aip.aip_187_25
Tompkins, T. L., & Witt, J. (2009). The short-term effectiveness of a suicide prevention gatekeeper training program in a college setting with residence life advisers. The Journal of Primary Prevention, 30(2), 131-149. https://doi.org/10.1007/s10935-009-0171-2
Tompkins, T. L., Witt, J., & Abraibesh, N. (2010). Does a gatekeeper suicide prevention program work in a school setting? Evaluating training outcome and moderators of effectiveness. Suicide & Life-Threatening Behavior, 40(5), 506-515. https://doi.org/10.1521/suli.2010.40.5.506
Wasserman, D., Hoven, C. W., Wasserman, C., Wall, M., Eisenberg, R., Hadlaczky, G., ... Carli, V. (2015). School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial. The Lancet, 385(9977), 1536-1544. https://doi.org/10.1016/S0140-6736(14)61213-7
Witry, M., Kauer, J., Fravel, M., Reist, J., & Viyyuri, B. (2020). Evaluation of a question persuade refer (QPR) training for student pharmacists. Mental Health & Prevention, 18. https://doi.org/10.1016/j.mhp.2020.200180